title: Perioperative pulmonary aspiration of patients who have had an esophagectomy with a gastric pull-up: the value of preoperative computed tomography of the neck.
abstract: Patients who have had an esophagectomy with gastric pull-up are at a higher risk for perioperative pulmonary aspiration due to loss of the esophageal sphincter. Altered neck anatomy following esophagectomy may render the conventional cricoid pressure maneuver unreliable in preventing pulmonary aspiration during induction of general anesthesia. Two patients who suffered perioperative pulmonary aspiration are presented. Retrospective review of their preoperative computed tomography of the neck showed the altered anatomical position of the esophago-gastric connection, causing the cricoid pressure to be ineffective.
authors.affiliation: Department of Anesthesiology, University of Pittsburgh Medical Center, University of Pittsburgh, Pittsburgh, PA 15213, USA.
authors.forename: Thomas E
authors.initials: TE
authors.lastname: Borsari
authors.forename: Ibtesam A
authors.initials: IA
authors.lastname: Hilmi
authors.forename: Tetsuro
authors.initials: T
authors.lastname: Sakai
mesh_terms: D000768:Anesthesia, General / Q000009:adverse effects / Q000379:methods; D016629:Esophagectomy / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006801:Humans; D008875:Middle Aged; D009333:Neck / Q000033:anatomy & histology; D011300:Preoperative Care / Q000379:methods; D053120:Respiratory Aspiration / Q000209:etiology*; D012189:Retrospective Studies; D013270:Stomach / Q000601:surgery; D014057:Tomography, X-Ray Computed / Q000379:methods*